Roles of stigma, discrimination, and healthcare empowerment in art adherence among people with HIV in the Dominican Republic

Abstract

Background: HIV-related stigma and intersecting sources of social marginalization undermine care, retention, and medication adherence among people with HIV (PWH). The impact of these stigmas may be exacerbated when perpetuated within healthcare settings. Biomedical interventions to improve survival prospects of PWH, reduce communal viral load, and reduce HIV incidence will not be successful without research to inform interventions to address stigma in healthcare facilities, particularly in resource-constrained environments. Methods: Baseline data from the Finding Respect and Ending Stigma around HIV (FRESH) project in the Dominican Republic were used for this study. Survey data on demographics, perceived discrimination (HIV status, race/ethnicity, sexual orientation), healthcare empowerment, visit satisfaction, HIV-related stigma, experience with HIV stigma programing, and the outcome of interest, self-reported antiretroviral (ART) adherence, were collected from patients (N=155) at two HIV clinics in the Dominican Republic. Descriptive statistics were examined and pearson’s correlations were calculated to assess associations between discrimination scales. Generalized multivariable linear regression analyses were used to assess predictors of ART adherence. Results: The sample was principally comprised of persons identifying as male (90%), gay (79%), Mulatto, Mestizo, or Multiracial (82%), and Catholic (59%). Over half had more than a postsecondary education (55%); 29% reported engaging in sex work, and 12% were migrants. Most had been living with HIV five or more years (51%), and did not have prior experience with stigma reduction programs (67%). Correlational analysis revealed significant associations between all discrimination measures (p< 0.0001). While adjusting for other predictors, being involved in sex work was negatively associated with ART adherence. Concerns about HIV status disclosure and having experienced sexual orientation discrimination were positively associated (p< 0.05). Prior experience with stigma reduction programming and healthcare empowerment were positively associated with adherence (p< 0.01). Conclusions: Results suggest that having HIV status disclosure concerns and perceiving sexual orientation discrimination may motivate some clients to have better ART adherence. In healthcare settings stigma reduction programs and promotion of healthcare empowerment have the potential to help clients to achieve optimal health outcomes.